Pessimism Deadly for Heart Patients?

Outlook Affects Survival, Study Shows, So Look on the Bright Side

Medically Reviewed by Elizabeth Klodas, MD, FACC on March 13, 2008
From the WebMD Archives

March 13, 2008 -- Keeping a positive attitude is good for your health, and if you are a heart patient it just may save your life, new research suggests.

A study of patients with heart disease followed for six to 10 years found that those with pessimistic beliefs about their recovery were twice as likely to die during that timeframe as those who felt more optimistic.

The research was presented this week in Baltimore at the annual meeting of the American Psychosomatic Society, a group dedicated to the research of the interaction between the mind and body.

"This study is one of the first to examine how a patient's attitude toward their disease affects their health over the long term, and ultimately their survival," says lead researcher John C. Barefoot, PhD.

Mind and Body Connection

Barefoot, Redford B. Williams, MD, and colleagues from Duke University Medical Center conducted psychological assessments on 2,825 patients hospitalized for heart disease.

The patients were asked to describe their expectations about their ability to recover from their illness and regain a normal life.

During six to 10 years of follow-up, 978 of the patients died, with 66% dying of heart disease.

Patient expectations about their disease course were highly related to survival, with patients who had the most pessimistic views dying at twice the rate of those who were most optimistic.

After controlling for factors that could influence survival, including disease severity, functional status, and depression, the death rate among the most pessimistic patients was still 30% higher than the most optimistic, Williams tells WebMD.

"Negative outlook was an independent predictor of poor outcomes," he says. "And there seems to be something protective about having a more optimistic attitude that makes you feel that you are going to be OK."

He says patients with positive expectations may be more likely to make lifestyle changes and follow treatment regimens prescribed by their doctors.

The Impact of Stress

Another possible explanation is that positive thoughts may lessen the damaging effects of stress on the body.

A separate study presented by the Duke researchers at the Baltimore meeting examined this theory.

Researchers conducted personality profiles on 327 healthy people to determine if they were more inclined to exhibit positive or negative emotions. They then conducted tests designed to assess the study participants' physiological responses to stress.

People identified as being more positive were found to have significantly lower increases in blood pressure during stress than people who were negative.

They also had lower levels of the stress hormone cortisol within 30 minutes of waking -- a time in which levels tend to be high.

"It's not just that negative emotions are harmful," lead researcher Beverly H. Brummett, PhD, tells WebMD. "There seems to be something about the experience of having more positive emotions. They seem to act as a buffer against bad health outcomes."

Brummett says interventions like meditation, behavioral therapy, and regular exercise may help people with naturally gloomy dispositions change their outlook.

But cardiologist Donald LaVan, MD, of the University of Pennsylvania, is not so sure.

LaVan, who is a spokesman for the American Heart Association, tells WebMD that very soon after the introduction of heart bypass surgery, cardiologists began to recognize that more optimistic patients fared better in terms of recovery and even survival.

This recognition led to the advent of the Zipper Club, a volunteer group made up of former heart surgery patients who help current patients deal with the emotional aspects of their illness.

LaVan says studies like the ones presented at the Baltimore meeting help advance the understanding of how emotions affect health.

"The conclusions are not too surprising, but the question becomes, 'Can you do anything to change someone's attitude?'" he says. "Maybe you can to some degree, but my clinical experience tells me that if a patient is walking around with a big black cloud over his head there's not much you can do about it."

Show Sources


American Psychosomatic Society annual meeting, March 12, 2008, Baltimore.

John C. Barefoot, PhD, Duke University Medical Center, Durham, N.C.

Redford B. Williams, MD, division head, Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C.

Beverly H. Brummett, PhD, research professor, Duke University Medical Center, Durham, N.C.

Donald LaVan, MD, spokesman, American Heart Association; clinical associate professor of medicine, University of Pennsylvania.

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